Patients who cannot communicate with doctors, nurses, other health professionals and caregivers are at increased risk for having adverse medical outcomes. Zubow and Hurtig (2013) reported that 14 percent of conscious hospitalized patients and 33 percent of intensive care unit patients were unable to independently activate standard nurse call systems. Based on those estimates and the annual U.S. hospital discharge rate, one can extrapolate that at least 3.9 million American patients may have required some form of assistive technology in order to be able to summon help and communicate with their healthcare providers. It is essential that solutions be found that allow intubated and physically weak patients to summon help and effectively communicate. By addressing the causes of adverse medical outcomes, U.S. hospitals have the potential to prevent 15,000 deaths, 450,000 complications, and $5 billion in avoidable costs. Innovation: The Iowa Adaptive Technologies Inc. (Voxello) team has developed, a smart switch (noddleTM) that allows patients, who have not been able to summon help or been able to use speech to communicate, to access the nurse call system, environmental controls and speech-generating devices. The development of the noddleTM used an iterative design approach that was informed by feedback from patients, who were being kept alive with mechanical ventilation, and whose physical conditions prevented them from accessing any existing nurse call pendants, switches, or other devices. To address the needs of patients, the noddle's patent pending signal- processing algorithm detects a patient's slightest intentional gesture and uses the resulting signal to enable the patient to control multiple devices. Consequently, patients who can only produce a tongue click, an eye blink or any other small motor gesture, can activate the nurse call and simultaneously control a speech-generating device. As a complement to the noddleTM, Voxello has developed content for a communication app (noddle-chatTM to allow non-speaking patients to effectively communicate with their healthcare providers thereby reducing the risk of adverse medical outcomes and increasing patient satisfaction. Voxello is working to obtain FDA clearance for the noddleTM. Approach: Voxello will conduct clinical trials to determine how easily the noddleTM and noddle-chatTM can be implemented across clinical settings to enable patients to summon their nurses and effectively communicate. Commercialization: Voxello will manufacture the noddleTM at a US based certified medical device facility and will develop the necessary distribution channels to serve the hospital, long-term care and home-care markets.